Cross-sectional assessment of exertional dyspnea in otherwise healthy children

Pediatr Pulmonol. 2014 Aug;49(8):772-81. doi: 10.1002/ppul.22905. Epub 2013 Oct 24.

Abstract

Objectives: Exertional dyspnea during sport at school in children with asthma or in otherwise healthy children is commonly attributed to exercise-induced asthma (EIA), but when a short-acting beta agonist (SABA) trial fails to improve symptoms the physician is often at a loose end.

Design: The aims were to prospectively assess the causes of exertional dyspnea in children/adolescents with or without asthma using a cardiopulmonary exercise test while receiving a SABA and to assess the effects of standardized breathing/reassurance therapy.

Results: Seventy-nine patients (12.2 ± 2.3 years, 41 girls, 49 with previously diagnosed asthma) with dyspnea unresponsive to SABA were prospectively included. Exercise test outcomes depicted normal or subnormal performance with normal ventilatory demand and capacity in 53/79 children (67%) defining a physiological response. The remaining 26 children had altered capacity (resistant EIA [n = 17, 9 with previous asthma diagnosis], vocal cord dysfunction [n = 2]) and/or increased demand (alveolar hyperventilation [n = 3], poor conditioning [n = 7]). Forty-two children who had similar characteristics than the remaining 37 children underwent the two sessions of standardized reassurance therapy. They all demonstrated an improvement that was rated "large." The degree of improvement correlated with % predicted peak V'O2 (r = -0.37, P = 0.015) and peak oxygen pulse (r = -0.45, P = 0.003), whatever the underlying dyspnea cause. It suggested a higher benefit in those with poorer conditioning condition.

Conclusions: The most frequent finding in children/adolescents with mild exertional dyspnea unresponsive to preventive SABA is a physiological response to exercise, and standardized reassurance afforded early clinical improvement, irrespective of the dyspnea cause.

Keywords: adolescent; asthma; child; dyspnea; exercise.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adrenergic beta-Agonists
  • Asthma / complications
  • Asthma / diagnosis
  • Asthma, Exercise-Induced / complications*
  • Asthma, Exercise-Induced / diagnosis
  • Case-Control Studies
  • Child
  • Cross-Sectional Studies
  • Dyspnea / diagnosis
  • Dyspnea / etiology*
  • Dyspnea / therapy
  • Exercise Test
  • Female
  • Forced Expiratory Volume
  • Hemosiderosis / complications*
  • Hemosiderosis / diagnosis
  • Humans
  • Lung Diseases / complications*
  • Lung Diseases / diagnosis
  • Male
  • Physical Exertion / physiology*
  • Physical Fitness
  • Prospective Studies
  • Vital Capacity
  • Vocal Cord Dysfunction / complications*
  • Vocal Cord Dysfunction / diagnosis

Substances

  • Adrenergic beta-Agonists

Supplementary concepts

  • Idiopathic pulmonary hemosiderosis